A team of social work, public health and medical scholars say improving access to quality mental health services may be the most effective public health strategy for ending the global HIV epidemic.
In a paper recently published in The Lancet HIV as part of a series exploring the advancement of science and policies around mental health and HIV services, UNC School of Social Work associate professor Rainier Masa and colleagues suggest that psychological care should be integrated with HIV prevention programs and interventions, especially as a growing amount of evidence continues to point to a link between mental health and HIV. The recommendations are based on a review of current literature examining the multiple factors that contribute to the global syndemic of HIV and mental health problems among men who have sex with men or MSM.
The researchers, including lead author Don Operario from the Rollins School of Public Health at Emory University, found that previous studies have shown that MSM face higher rates of depression, anxiety, substance use and trauma than the general population. There is also strong evidence that stigma and discrimination contribute to disproportionate mental health problems and HIV transmission within the MSM population, Masa explained.
“For so many years, we’ve been so focused on the biomedical aspects of HIV prevention, and now we’re recognizing how mental health and HIV are linked,” said Masa, who conducts research on the intersection of economic security and HIV among adolescents and young adults. “This is the first paper to really call for integrating mental health and HIV services.”
Historically, public and private agencies and organizations that work in HIV prevention provide counseling to clients after they receive news of a positive test. However, very few of these same agencies offer mental health services early as a strategy for preventing HIV infections, especially among key populations, including Black and Latino MSM, Masa said.
“We know that a lot of these young men are engaging in risky behaviors and that they have experienced trauma and have unmet mental health needs,” he said. “Yet, we don’t know how to help them. Instead, we focus so much on the need to use condoms or to take medications to reduce the chances of infection. But for these men, there are other issues that are more important, and that is their mental health. We know that poor mental health increases drug use and that when you use drugs, you may not use protections. So, we can no longer deny that mental health is an important component of HIV prevention.”
Addressing the mental health needs of MSM will likely require grassroot efforts, especially from agencies in countries where homosexuality continues to be criminalized and from those already working closely with key populations, including the transgender community, the researchers concluded.
The paper will be presented at the 24th International AIDS Conference in Montreal, Canada. Masa hopes the paper’s findings may also help to inform a federally funded study he is currently leading that examines how intersectional stigma and resilience affect HIV testing and adherence to HIV prevention medications among young Latinx sexual minority men in North Carolina.
“Ultimately, we cannot end HIV if we are not going to address the underlying issues that are affecting the mental health of sexual and gender minorities,” Masa added. “ That will require addressing the impact of violence, stigma and discrimination on underlying mental health issues.”